Urgent Care (8 page)

“Yes, please.” She wrung her hands together, realized what she was doing, and instead pressed them flat against the counter as she waited. Jerry must have answered immediately because Jason handed her the phone a few moments later.

“Nora,” Jerry said, his words undercut by the sound of traffic. “What can I do for you?”

“I was wondering if we could talk.” She looked around; too many people here at the nurses’ station. “About this morning.”

“Was there something you needed to add to your statement? Want me to send Janet back?”

“No, no, don’t bother Janet.” She laid her forehead against her palm. Last thing she needed was another interrogation from Janet. “I know you’re busy—”

A man’s voice shouted to Jerry in the distance. “I’m coming,” he called back. “Sorry, Nora. It’s a bit crazy. Listen, I’m meeting Lydia tomorrow morning around seven—want to ask her about coming along? Unless it’s urgent; I can try to get free—” His words were crowded out by the sound of other voices.

Nora sighed. “No, it’s not urgent. Tomorrow’s fine.”

“You sure?”

“I’m sure.” She hung up, sapped. It had taken all of her energy to build up the courage to talk to Jerry.

Lydia hung up the phone with a bang. “Idiots!”

A middle-aged man wearing a wool overcoat came barreling into the ER from the ambulance bay. “Where is Dr. Fiore and what the hell is she doing interfering with my patient?”

“Uh-oh,” Jason muttered. “Better run for cover.”

Lydia turned to the man with a wide smile. A smile so fake that Nora could see Lydia’s jaw muscles spasm with the effort. “Dr. Frantz, I presume?”

 

 

LYDIA’S TEMPER SNAKED THROUGH HER—IT HAD been a bad day, a frustrating day, a day that seemed to churn up all the anger, fear, and anxieties of her youth. Usually she could compartmentalize, shove aside outside worries, but not today.

Damn it, she wasn’t going to abandon Narolie to the idiots in the clinic or assholes like the one who stood before her.

“Your patient is in our isolation room, waiting for you,” she told Frantz, biting back the adjectives she wanted to use. “His mother is with him. He’s fine—although his rash has a petechial appearance, it’s not classic for meningococcemia.”

“Labs?” Frantz demanded, handing his scarf and coat to Jason as if the ER had a coat check.

“Normal except for a slightly low white count.”

He yanked the paper from her hand. “I’m sure you’re aware that a low white count is a sign of sepsis.”

“It’s also consistent with a virus—look at the lymphocyte predominance.”

“Then why does he have bands, if it’s only a virus?” He raised his gaze to sneer at her. “I know you ER docs consider yourselves masters of all aspects of medicine, but I think the subtleties of early sepsis are beyond you. Good thing I acted fast to treat him.”

“Yes, giving that preemptive high dose of ceftriaxone was very helpful.” Her sarcasm was lost on Frantz. “It destroyed any chance of our culturing his blood and proving that he has meningococcemia. And the mother refused a lumbar puncture. Getting spinal fluid could be our last chance to confirm the diagnosis. But if we’re going to do it, we need to move fast.”

“Hmpf.” Frantz ignored her, leafing through his patient’s chart. “Call in an infectious-disease consult and get neurology down here to do the spinal tap. I’ll get the mom’s consent. By that time his bed in the PICU should be ready.”

“Don’t you want to examine the patient before calling in consults?” Asking a neurologist to come down to the ER to do a simple LP was like calling a plastic surgeon to trim a hangnail.

“No. Like you said, time is of the essence. Make the calls. I’m going to talk with my patient and his family.” Without a glance, he left the nursing station.

“Gee, Lydia, didn’t know you were aiming for my job working the phones,” Jason said with a grin. “It’s harder than it looks, you know. I’m not sure if you’re qualified.”

“Hah. Very funny. You call in the ID consult—I think Ken Rosen is on for them. I’ll call neuro and try to explain why they’re being asked to drop everything to do a simple spinal tap.” No sense in Jason getting chewed out on Frantz’s behalf.

Lydia slid into a chair—it felt like the first time she’d sat down all day. As she waited for the neurologist to return her page, she watched Nora. The charge nurse was flipping through the triage notes of patients waiting to be seen, prioritizing them, making notes on patients who would need follow-up in the waiting room if they weren’t seen soon, and creating a list of orders—obvious labs, X rays, and the like—to help facilitate the process.

Yet Nora seemed to be moving at half speed, reading a chart, then moving on, checking herself, and going back. Distracted. Lydia fingered the small flash drive Boyle had given her, rubbing it like a worry bead before slipping it back into the pocket of her scrubs. She understood the feeling. But the ER was no place to be working when you were distracted. Good thing it wasn’t too busy.

The phone rang. “Lucas Stone here,” came a man’s voice. “Someone page neurology?”

Thank goodness it was Lucas—he wouldn’t mind doing the LP; he loved procedures, even simple lumbar punctures. Plus, ever since he and Amanda had announced their engagement after Thanksgiving, he’d been incredibly easygoing about everything. Lydia couldn’t remember the last time they’d gotten into one of their usual good-natured debates. Or that she’d been able to get him started on a rant. Although he was still as germophobic as always—but she hated to tease him about that. Not with more important things like the wedding on his mind.

At least she didn’t have to worry about Trey ever getting googly-eyed like Lucas. What she and Trey had was good, was great, but it definitely wasn’t headed anywhere near an altar. Not anytime soon. Thank God. It was hard enough handling living with someone, much less ’til death do us part.

“Lucas, it’s Lydia. I’m going to apologize up front, but it’s not my call. I have a private patient down here; his attending is certain he has meningococcemia, although I don’t buy it. Anyway, the attending, a Dr. Frantz, wants you to do the LP.”

There was a pause and she almost hoped that Lucas would snap at her—or at least vent a little at Frantz’s stupidity. But no, instead he merely said, “When do you need me?”

“Well, to complicate things, the kid got a slug of antibiotics before he even hit the ER. So the clock’s ticking.”

“No problem, I’ll be right down. Oh, and I have those bridesmaid dresses for you to look at.” He hung up before he could hear Lydia groan.

To prevent any perception of a conflict of interest because Lucas was an attending physician, Amanda and Lucas wanted to be married before Amanda began her internship in July. But as a medical student, Amanda was too busy to plan a wedding, so Lucas—being more than a little obsessive-compulsive—had taken over the plans. And was surprising everyone by apparently enjoying the process.

Nora joined her at the desk, shuffling the triage charts. Lydia flipped through them, signing orders for the labs and X rays.

“When Lucas comes down, tell him the spinal tap kid is in the isolation room.”

“Where are you going?” Nora asked.

“To check on my patient in bed two. But don’t tell him that—he has more bridesmaid dresses for us to look at.”

“I haven’t even found a dress to wear to the gala on Saturday and he expects me to pick out something for a wedding that’s not until May?”

“I thought you were working Saturday.”

“I am, but only seven to three. I promised admin that I’d be at the gala by four—they asked all the charge nurses to act as hostesses.”

“You don’t sound too happy about it. Want to trade places? Trey has me signed up for a cookie-baking marathon with his mother.”

“It’d be different if I had a date. And”—Nora shook her head, a frown creasing her eyes—“getting all dressed up seems so frivolous after what happened today.”

Lydia watched the expressions flit across Nora’s face. Something beyond Karen’s death was troubling her. Lydia wasn’t sure whether to push the issue or let it be.

Nora solved the problem by standing up. “I’m going to look for that rape kit. It has to be around here somewhere.”

 

 

AMANDA PULLED THE CURTAIN ASIDE AND WAS immediately struck by the delicate beauty of the girl sleeping in the bed beyond it. High cheekbones that would put even Gina’s to shame; an ebony complexion so dark it was almost blue; small, delicate hands with long fingers. Wow. And Narolie was only thirteen—wait until she came into her own as an adult.

The girl was alone. She looked so peaceful that Amanda hated to wake her. But as Amanda approached, a spasm of pain contorted the girl’s face and she clutched her belly, arching up as if about to vomit. Amanda rushed to grab the emesis basin from the girl’s bedside, holding it at the ready.

Sweat coated Narolie’s face as the pain racked her body. Then she relaxed and pushed the basin aside. “I’m okay,” she said in a strangled whisper, eyes still closed. “I’ll be okay.”

“Narolie? I’m Amanda Mason. I’m here to see about getting you a bed upstairs so we can find out what’s wrong with you.”

Narolie opened her eyes fully and turned her gaze to Amanda. “And heal me, yes? Please, I need to be healed. I have prayed and prayed and now you are here, the answer to my prayers.”

Another wave of pain brought tears to the girl’s eyes as she clutched Amanda’s hand with crushing strength. “Please,” she repeated.

“I’ll do the best I can,” Amanda vowed. After the spasm passed, she kept hold of Narolie’s hand. The girl was so young, so alone. “When did the pain begin?” she asked, settling in to take Narolie’s history.

They’d barely begun when the curtain parted and a man in a dark blue suit entered. “I was told we have a mystery patient here,” he said, extending a hand for Narolie’s chart.

Amanda held on to the chart and stood up. Before she could ask, he said, “I’m Dr. Frantz, and you, I believe, are Amanda Mason?”

“Yes.” She stood up straighter. Dr. Frantz was one of the private pediatricians with attending privileges at Angels. He never let medical students or residents near his patients. And he never, ever saw clinic patients—his patients were the elite of Pittsburgh. “Can I help you?”

“Actually, I think I can help you. The nurses said you were having a hard time getting an attending for your case.” He nodded at Narolie as if she were a lab specimen. “I’m here seeing one of my patients and while I’m waiting for a few consults, I thought I’d see if I could help out.”

“Uh—sure, that would be great.” This wasn’t the Dr. Frantz she’d heard about—the man who called medical students “scut-monkeys” and residents “gorillas.” She handed him the chart. “This is Narolie. She began to experience dizziness, headaches, and vomiting—”

“No need for the full history, I have it all right here.” He gestured with the chart, motioning for her to join him outside in the hall. “What’s your plan?”

“Admit her for pain control, IV fluids, and further testing. CT should be ready for her shortly. If that’s negative, I’d like to also do an MRI, rule out any mass—”

“Evidence of increased intracranial pressure on exam?”

“Well, no, but—”

“Then a brain tumor that wouldn’t be seen on CT is highly unlikely. I see she’s from Africa—stool studies?”

“The clinic has already done them four times. No evidence of parasites. And she’s never had any diarrhea.”

“Still, those can be pesky buggers to track down. Since the ER already has it set up, I guess we can go ahead with the CT. Write up the orders for her IV and some Zofran, and I’ll take it from there.”

“Don’t you want to exam her?”

He beamed down at her. “I’m on the match committee for the pediatrics residency program, Ms. Mason. I’ve seen your application to match here in pediatrics. Excellent recommendations. You’ve garnered some high praise from the attendings you’ve worked under. I think I can trust your exam. Dictate the history and physical and the admission note and I’ll sign them.”

Lucas appeared from the direction of the nurses’ station. “Dr. Frantz?”

Amanda was surprised at the deferential tone in Lucas’s voice. Lucas was the youngest attending in neurology, but usually that didn’t stop him from being a stubborn and sometimes loudly intense patient advocate—one of the reasons she’d fallen in love with him.

Dr. Frantz turned his attention to Lucas as if he were granting Lucas a royal audience. “Stone. Good to see you again. How’d the LP on my little guy look?”

“Normal opening pressure, fluid was clear. I’m waiting for labs, but I didn’t find any signs of meningitis on exam.”

“Good, good. Harold’s mother will be pleased to hear that.”

“I’ll dictate a note, page you if anything shows up on the gram stain.”

“You’ll go look yourself?” Dr. Frantz made it sound like a statement rather than a question.

Lucas glanced at his watch. “Sure, no problem.”

“Very good.” Dr. Frantz turned to leave, then stopped, including both of them in his beaming gaze. “By the way, I understand congratulations are in order. I wish you the best of luck and hope Ms. Mason is able to continue working here at Angels. It would be such a pity if things went awry and she didn’t match here, had to leave us.”

Amanda watched him walk away, then turned to Lucas. “Why do I feel like I’ve just been threatened?”

Thursday, 12:17 P.M.

NORA ABANDONED HER PAPER SHUFFLING AND walked down to OR 13. The police had placed a large X of crime-scene tape across the double doors, like on TV. The yellow tape looked bizarre, surrealistic. But what had happened behind those doors was all too real.

She shook herself and looked down the hall. OR 13 was in the back of the ER, at the end of a short corridor. The only other rooms down here were the locker rooms and clean holding. Then was the intersection with one of the main ER corridors: turn left and there was security, the trauma rooms, nursing station, and at the end, the ambulance bay. Turn right and you’d hit the corridor leading to administration, the conference rooms, cafeteria, atrium, and auditorium. Or you could loop back around into the ER.